In spite of the well-researched influence of alcohol on injury incidence and the socio-economic consequences of injuries in the US, only a few studies have compared utilization of health care resources between alcohol and non-alcohol involved injuries. The few studies that do exist had one or more of the following limitations. First, they only focused on acute intoxication as a predictor of over-utilization of health services. Therefore, the potential influence of dependence to alcohol on resource utilization has seldom been the topic of research. Second, they relied solely on trauma registries that have very limited information about - alcohol consumption, resource utilization and cost estimation. Third, pre-hospital resource utilization has not been taken into consideration. Fourth, they did not differentiate between early (first 24 hours of emergency department (ED) arrival) and late (after the first 24 hours of ED arrival) resource utilization. Fifth, the influence of sex and race/ethnicity as potential variables which may modify the association between alcohol consumption and pre-hospital and hospital resource utilization, has not been evaluated. By linking four databases related to injuries from an urban level I trauma center, the current study proposes to estimate the extra-burden of injuries imposed by individuals with high BAC in the ED and/or dependence to alcohol on emergency medical service (EMS) system and the hospital health care system. We will place special emphasis on sex and race/ethnicity as potential effect modifiers. The primary strength of the proposed study is using data from a clinical trial that has detailed information about alcohol consumption, beyond acute BAC in the ED, for trauma patients. The specific aims of the proposed study are: 1) To compare the pre-hospital resource utilization between alcohol- and non-alcohol involved injuries;2) To compare the cost of pre-hospital care between alcohol- and non-alcohol involved injuries;3) To compare the early vs. late hospital resource utilization (i.e., procedures conducted in the first twenty four hours following admission vs. thereafter) between alcohol- and non-alcohol involved injuries;4) To compare the cost of hospital care between alcohol- and non-alcohol involved injuries;5) To evaluate whether sex or race/ethnicity modifies the association between alcohol consumption and over- utilization of pre-hospital and hospital resource use and cost of care;6) To evaluate the validity of using "multiple imputation" method for dealing with missing data in studies that use trauma registries with more than 60% missing values for BAC in the ED. The proposed study will provide evidence as to the necessity of improving existing or implementing new alcohol screening programs in large urban level I trauma centers that are responsible for providing care to the most disadvantaged groups of the population. PUBLIC HEALTH RELEVANCE: Alcohol is involved in 40-50% of the hospitalizations in level I and II trauma centers. This study evaluates the extra-health care utilization due to alcohol-involved injuries in pre-hospital and in-hospital setting, after adjustment for potential confounding variables. In this study, we will place special emphasis on gender and race/ethnicity as potential variables that might influence the association between blood alcohol concentration and resource utilization in trauma centers. The primary strength of the proposed study is linking pre-hospital and hospital data to a clinical trial that has detailed information about alcohol consumption pattern, beyond acute blood alcohol concentration in the emergency department for trauma patients. The proposed study will provide evidence as to the necessity of improving existing or implementing new alcohol screening programs in large urban level I and II trauma centers that are responsible for providing care to the most disadvantaged groups of the population.